Medical management of sports-related concussion is evolving. In recent years, there has been a significant amount of research into sports-related concussion in high school athletes. Plano West Lacrosse Club (PWLC) is establishing this protocol to provide education about concussion for Coaches and other personnel, and to aid players and their families. This protocol outlines procedures for coaching staff and athletic trainers (AT) to follow in managing head injuries, and outlines club policy as it pertains to return to play issues after concussion.

PWLC seeks to provide a safe return to activity for all athletes after injury, particularly after a concussion. In order to effectively and consistently manage these injuries, procedures have been developed to aid in insuring that concussed athletes are identified, treated and referred appropriately, receive appropriate follow-up medical care.

Recognition of concussion

Common signs and symptoms of sports-related concussion

1.Signs (observed by others):

Athlete appears dazed or stunned

Personality change

Confusion (about assignment, plays, etc.)

Responds slowly to questions

Forgets plays

Forgets events prior to hit

Unsure about game, score, opponent

Forgets events after the hit

Moves clumsily (altered coordination)

Loss of consciousness (any duration)

Balance problems

2.Symptoms (reported by athlete):

Headache

Feels sluggish

Fatigue

Feels “foggy”

Nausea or vomiting

Problems concentrating

Double vision, blurry vision

Problems remembering

Sensitive to light or noise

These signs and symptoms are indicative of probable concussion. Other causes for symptoms should also be considered.

Cognitive impairment

Assessed by simple sideline cognitive testing.

ImPACT neuropsychological testing

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is a research-based software tool utilized to evaluate recovery after concussion. It was developed at the University of Pittsburgh Medical Center (UPMC). ImPACT evaluates multiple aspects of neurocognitive function, including memory, attention, brain-processing speed, reaction time, and post-concussion symptoms.

Neuropsychological testing is utilized to help determine recovery after concussion.

2.Players in grades 7-12 should take a baseline test prior to the start of the lacrosse season, which is good for two years.

From time to time, PWLC may make ImPACT testing available to our registered players. Parent not present with their child, who are minors, on the day of the test will be required to have their parents sign a consent form. This form will be provided by the Impact Testing Facility.

Guidelines and procedures for coaches:

RECOGNIZE, REMOVE, REFER

Recognize concussion

All coaches should become familiar with the signs and symptoms of concussion described in section I.

Coaches will be provided with cognitive assessment cards that will aid coaches in accessing players. These cards will be provided by the Impact Testing Facility.

Remove from activity

If a coach suspects the athlete has sustained a concussion, the athlete will be removed from activity until evaluated medically.

A member of the coaching staff or team administrator (TA) will call the athlete’s parents to inform them of the removal from activity and to coordinate a ride for the player.

In the event that an athlete’s parents cannot be reached, and the athlete is able to be sent home (rather than directly to MD):

The Coach or TA will insure that the athlete will not drive themselves home and be with a responsible individual, who is capable of monitoring the athlete and understanding the home care instructions, before allowing the athlete to go home.

If there is any question about the status of the athlete, or if the athlete cannot be monitored appropriately, the athlete should be referred to the emergency department for evaluation.

Refer the athlete for medical evaluation.

Players need to be evaluated and cleared by their doctor.

Or they may be evaulated at Ben Hogan Concussion Center.Medical Office Building I6130 W. Parker Rd., #516Plano, TX 75093Phone: 972-981-7195

RETURN TO PLAY PROCEDURES AFTER CONCUSSION

Coaches are required to see a written clearance from primary care physician or specialist prior to resuming lacrosse activity (athlete must be cleared for progression to activity by a physician other than an Emergency Room physician).

Once the above criteria are met, the athlete will be progressed back to full activity following a stepwise process, (as recommended by both the Prague and NATA Statements), per recommendations of their primary care physician or specialist.

Progression is individualized, and will be determined on a case by case basis. Factors that may affect the rate of progression include: previous history of concussion, duration and type of symptoms, age of the athlete, and sport/activity in which the athlete participates. An athlete with a prior history of concussion, one who has had an extended duration of symptoms, or one who is participating in a collision or contact sport will be progressed more slowly.)

Stepwise progression as described in the Prague Statement:

No activity – do not progress to step 2 until asymptomatic

Light aerobic exercise – walking, stationary bike

Sport-specific training (e.g., running in lacrosse)

Non-contact training drills

Full-contact training after medical clearance

Game play

Note: Guidelines suggest: if the athlete experiences post-concussion symptoms during any phase, the athlete should drop back to the previous asymptomatic level and resume the progression after 24 hours.

Background: The following documents/websites were consulted in developing this protocol. The “Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004” 2(referred to in this document as the Prague Statement), and the “National Athletic Trainers’ Association Position Statement: Management of Sport-Related Concussion” 3(referred to in this document as the NATA Statement).

American Academy of Pediatrics recent review “Clinical Report—Sport Related Concussion in Children and Adolescents. American Academy of Pediatrics (Pediatrics Vol 126, 3, 2010)